# Pancreatic cancer drugs in England: NICE appraisals and the Cancer Drugs Fund (September 2026)

Source: https://onco.cc/terms/pancreatic-cancer-uk-drug-access/  
OnCo record `pancreatic-cancer-uk-drug-access` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In England the funded pancreatic cancer drugs are the older chemotherapies: FOLFIRINOX, gemcitabine with capecitabine, gemcitabine alone, and nab-paclitaxel with gemcitabine when other combinations are unsuitable. Liposomal irinotecan after gemcitabine was turned down in 2017, the olaparib and NALIRIFOX appraisals ended without a submission, and the 2026 drugs were unappraised.

## Summary

What NICE has decided. TA25 (8 May 2001) recommended gemcitabine and has been replaced by the guideline NG85. TA476 (6 September 2017, replacing TA360) recommends nab-paclitaxel with gemcitabine for untreated metastatic adenocarcinoma of the pancreas only if other combination chemotherapies are unsuitable and the person would otherwise have gemcitabine alone, with the patient access scheme discount. TA440 (26 April 2017) does not recommend pegylated liposomal irinotecan with fluorouracil and leucovorin after gemcitabine-based therapy. NG85 (7 February 2018, with prescribing notes updated to September 2025) offers FOLFIRINOX first line for performance status 0 to 1 and gemcitabine combinations or gemcitabine alone for those less fit (1.9.4 to 1.9.6), oxaliplatin-based or gemcitabine-based second-line chemotherapy (1.9.7 and 1.9.8), adjuvant gemcitabine plus capecitabine or gemcitabine alone (1.8.6 and 1.8.7), neoadjuvant therapy only within a trial (1.8.1 and 1.8.2), and systemic combination chemotherapy for locally advanced disease with capecitabine as the radiosensitiser when chemoradiotherapy is used (1.9.1 to 1.9.3); several of these uses are recorded as off-label. Tumour-agnostic drugs: larotrectinib for NTRK fusion-positive solid tumours is available through the Cancer Drugs Fund under a managed access agreement (TA630, 27 May 2020); entrectinib was in the Fund under TA644 (12 August 2020) until that appraisal was replaced by the terminated TA1118 (7 January 2026), because the company did not make a submission, and only people already on treatment continue. Pembrolizumab for mismatch repair deficient tumours (TA914, 20 September 2023) covers endometrial, gastric, small intestine, biliary and colorectal cancer and does not name pancreatic cancer.

What NICE has terminated or not appraised. Two appraisals ended without a recommendation because the companies made no evidence submission: olaparib for maintenance treatment of BRCA mutation-positive metastatic pancreatic cancer (TA750, terminated 8 December 2021) and pegylated liposomal irinotecan with oxaliplatin, fluorouracil and leucovorin, NALIRIFOX (TA1052, terminated 2 April 2025). Searches of nice.org.uk on 24 September 2026 for daraxonrasib, zenocutuzumab, tumour treating fields and sotorasib returned no pancreatic appraisal (sotorasib has TA781 for lung cancer only), and the in-development list carried only zolbetuximab for claudin 18.2-positive disease (ID6444). The Scottish Medicines Consortium was not read for this page. The practical gap between the United States and England is therefore daraxonrasib (FDA approval 26 August 2026), NALIRIFOX (FDA 13 February 2024), olaparib maintenance for germline BRCA carriers (FDA 2019), zenocutuzumab for NRG1 fusions (FDA 4 December 2024) and Optune Pax (2026), none of which is routinely commissioned in England, while liposomal irinotecan after gemcitabine is licensed in the EU and UK but not recommended.

## Fields

- Kind: Term
- Last checked: 2026-09-24
- Also known as: NICE pancreatic cancer; Pancreatic cancer NHS funding; Cancer Drugs Fund pancreatic

## Sources

- NICE TA476: nab-paclitaxel with gemcitabine for untreated metastatic pancreatic cancer (6 September 2017): https://www.nice.org.uk/guidance/ta476
- NICE TA440: pegylated liposomal irinotecan after gemcitabine, not recommended (26 April 2017): https://www.nice.org.uk/guidance/ta440
- NICE NG85: pancreatic cancer in adults, recommendations 1.8 and 1.9: https://www.nice.org.uk/guidance/ng85/chapter/Recommendations
- NICE TA25: gemcitabine for pancreatic cancer (8 May 2001, replaced by NG85): https://www.nice.org.uk/guidance/ta25
- NICE TA630: larotrectinib for NTRK fusion-positive solid tumours, Cancer Drugs Fund (27 May 2020): https://www.nice.org.uk/guidance/ta630
- NICE TA750: olaparib maintenance for BRCA mutation-positive metastatic pancreatic cancer, terminated appraisal (8 December 2021): https://www.nice.org.uk/guidance/terminated/ta750
- NICE TA1052: pegylated liposomal irinotecan in combination (NALIRIFOX) for untreated metastatic pancreatic cancer, terminated appraisal (2 April 2025): https://www.nice.org.uk/guidance/terminated/ta1052
- NICE TA1118: entrectinib for NTRK fusion-positive solid tumours, terminated appraisal (7 January 2026): https://www.nice.org.uk/guidance/terminated/ta1118
- NICE TA914: pembrolizumab for MSI-high or mismatch repair deficient endometrial, biliary, colorectal, gastric or small intestine cancer (20 September 2023): https://www.nice.org.uk/guidance/ta914
- FDA oncology approval notifications (daraxonrasib 26 August 2026, zenocutuzumab 4 December 2024, irinotecan liposome first line 13 February 2024): https://www.fda.gov/drugs/resources-information-approved-drugs/oncology-cancer-hematologic-malignancies-approval-notifications

## Connected records

- cancers: [BRCA or PALB2-mutant pancreatic ductal adenocarcinoma](https://onco.cc/cancers/brca-palb2-pdac/), [KRAS wild-type pancreatic ductal adenocarcinoma](https://onco.cc/cancers/kras-wild-type-pdac/), [Metastatic pancreatic ductal adenocarcinoma](https://onco.cc/cancers/metastatic-pdac/), [Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma](https://onco.cc/cancers/msi-high-pdac/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [Daraxonrasib](https://onco.cc/drugs/daraxonrasib/), [Entrectinib](https://onco.cc/drugs/entrectinib/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/), [Larotrectinib](https://onco.cc/drugs/larotrectinib/), [Liposomal irinotecan](https://onco.cc/drugs/liposomal-irinotecan/), [Nab-paclitaxel](https://onco.cc/drugs/nab-paclitaxel/), [NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)](https://onco.cc/drugs/nalirifox/), [Olaparib](https://onco.cc/drugs/olaparib/), [Optune / Optune Pax (TTFields)](https://onco.cc/drugs/optune/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Sotorasib](https://onco.cc/drugs/sotorasib/), [Zenocutuzumab](https://onco.cc/drugs/zenocutuzumab/)
- institutions: [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/)
- terms: [Accelerated approval](https://onco.cc/terms/accelerated-approval/), [Cancer Drugs Fund (England)](https://onco.cc/terms/cancer-drugs-fund/), [Tumour-agnostic (tissue-agnostic) approval](https://onco.cc/terms/tumour-agnostic/)
- trials: [CONKO-001](https://onco.cc/trials/conko-001/), [ESPAC-4](https://onco.cc/trials/espac-4/), [NAPOLI-1](https://onco.cc/trials/napoli-1/)

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